Thinking Fast and Slow

ON A FRIDAY EVENING in November 2016, a 20-year-old medical student sat behind a mound of papers in a crowded college library, cramming for an upcoming examination on pathology and forensic medicine. The student, in his second year at DY Patil Medical College in Pune, was panicking about the amount that he had left to study. Later that night, he complained to a friend about the formidable syllabus. The friend gave him a small, white pill, insisting that it would help with concentration. He took it on Saturday evening and revised through the night, then took another one on Sunday evening, and studied all of the following night as well.

The student managed to make it to the examination hall on time on Monday morning, but blanked out when the question paper was placed in front of him. Despite having spent the weekend reviewing incessantly, there were substantial parts of the syllabus that he could not remember, and he was seized by another bout of panic. “His hands started trembling and it looked like he was having a fit. He submitted an almost blank sheet of paper and ran out of the examination hall,” a 22-year-old classmate of the student later recounted to me.

“He had to keep studying all the time,” his classmate said, adding that, in the lead-up to the exam on Monday, the student had grown “obsessive” and pored over his textbooks with an almost manic absorption. While revising the microscopic features of specimens that he would have to identify on slides in the examination, he revisited the same paragraph repeatedly to assuage his anxiety about having missed any minor details.

Even after the ordeal of the examination, the student was unable to catch up on the sleep that he had sacrificed to study. His eyes would not close, and “he was anxious, irritable and restless through the day.” Despite refraining from taking more of the pills, he was unable to sit still, his hands continued to tremble and he fidgeted constantly. Conversing with him became almost impossible. He would “suddenly start a third topic while I was talking. He had sudden bursts of anger and tantrums.” For example, the classmate told me, “he got very angry if a person didn’t pick up his call.”

Many of modafinil’s frequent users takeit to ward off exhaustion while working incessantly. Researchers on cognitive enhancers have speculated about whether it induces a single-minded focus that is antithetical to the creative process.